Healthcare Provider Details

I. General information

NPI: 1720534811
Provider Name (Legal Business Name): RHEUMATOLOGY SPECIALISTS OF CONNECTICUT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 SULLIVAN AVE
SOUTH WINDSOR CT
06074-2711
US

IV. Provider business mailing address

1504 SULLIVAN AVE
SOUTH WINDSOR CT
06074-2711
US

V. Phone/Fax

Practice location:
  • Phone: 860-432-8400
  • Fax: 860-432-8430
Mailing address:
  • Phone: 860-432-8400
  • Fax: 860-432-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number037380
License Number StateCT

VIII. Authorized Official

Name: TIMOTHY QUAN
Title or Position: OWNER
Credential: MD
Phone: 860-432-8400